In high-risk infants, early application of emollients is an effective strategy for the prevention of atopic dermatitis (AD), and emollient emulsion may be the optimal type of treatment, according to the results of a systematic review and network meta-analysis published in the Journal of the European Academy of Dermatology and Venereology.
Recognizing that the differences among the various emollients remains unknown, the researchers conducted a network meta-analysis to compare different emollients for preventing AD in infants. Investigators noted that if patients are not well managed, AD can be associated with poor quality of life and increased disease burden.
The current systematic review and network meta-analysis was performed to address whether early application of emollients in infancy can effectively prevent the subsequent development of AD and which types of emollients may be optimal options for preventing the development of AD. Relevant studies were identified from the establishment date of each database used in the literature search — including PubMed, EMBASE, and the Cochrane Controlled Register of Trials (CENTRAL) — through February 28, 2022.
The studies selected for review needed to fulfill the following criteria:
- Infants with no AD at the point of recruitment could be included as participants, regardless of their baseline risk.
- Participants in the experimental group received emollients, whereas those in the control group received standard care, including no treatment or similar adjuvant skin interventions in the experimental group.
- Studies reported at least the development of AD following the intervention; and
- The studies were designed as randomized controlled trials (RCTs), with the results reported in full texts.
Additionally, if a target comparison was available for a study with a multiple-arm design (ie, >2 arms), that analysis was included for data analysis as well.
A total of 802 relevant studies were retrieved from the literature search, with only 10 RCTs determined to meet the study selection criteria. Further, 1 eligible study was identified from a previous meta-analysis. Ultimately, 11 eligible studies that included a total of 3483 participants were included in the network meta-analysis.
Among the included studies, 3 types of emollient were identified — that is, cream, emulsion, and mixed types. Results of the study demonstrated that all eligible studies reported the development of AD following early emollient application, with the meta-analysis suggesting a significantly lower incidence of AD among all populations receiving emollients (risk ratio [RR], 0.75; 95% CI, 0.57 to 0.99; P =.001). Findings from subgroup analyses further suggested that early application of emollients significantly prevented the development of AD among high-risk populations (RR, 0.64; 95% CI, 0.47 to 0.88).
According to the network meta-analysis, emollient emulsion might be the preferred option for the prevention of infant AD development, with a surface under the cumulative ranking curve (SUCRA) of 82.6% for all populations, 78.0% for high-risk populations, and 79.2% for populations with a food sensitization. Participants treated with emollients vs those who were not more often reported the development of adverse events.
The current meta-analysis has some limitations that should be noted. To begin, studies that directly compared different emollient types with each other were not available for evaluation. Further, some eligible studies were at high risk for performance and detection bias domains, which may impair the reliability of the present study findings. In addition, although a subgroup analysis was conducted, considerable heterogeneity across studies was observed.
Study authors concluded that, “The results of this systematic review and network meta-analysis show that early application of skin emollients can effectively prevent AD development in infants.”
Liang J, Hu F, Tang H, et al. Systematic review and network meta-analysis of different types of emollient for the prevention of atopic dermatitis in infants. J Eur Acad Dermatol Venereol. Published online November 23, 2022. doi:10.1111/jdv.18688